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The organisation that ensures fair global access to Covid-19 vaccines is looking at changing its rules after the UK got more doses than Botswana, despite having better vaccine coverage.

Reuters reports that in March, as Britain led the world in vaccination rates and almost half its people had received a shot, Covax, the organisation meant to ensure fair global access to Covax-19 vaccines, allotted the country over half a million doses from its supplies.

By contrast, Botswana, which hadn’t even started its vaccination drive, was assigned 20,000 doses from the same batch of millions of Pfizer mRNA vaccines, according to publicly available documents detailing Covax’s allocations.

Other poorer nations, with fledgling vaccination drives at best, also received fewer shots than Britain. Rwanda and Togo were each allotted about 100,000 doses, and Libya nearly 55,000.

The distribution was driven by the methodology used by Covax, a programme co-led by the World Health Organization, the Coalition for Epidemic Preparedness Innovations (CEPI) and the Global Alliance for Vaccines and Immunization (Gavi). Since January, it has largely allocated doses proportionally among its members according to population size, but regardless of their vaccination coverage.

This made some rich nations, which already had many vaccines through separate deals with pharmaceutical firms, eligible for Covax doses alongside countries with no vaccines at all.

Six months later, Covax is planning to overhaul the allocation methodology to ensure it takes into account the proportion of a country’s population that has been vaccinated, including with shots bought directly from drugmakers, according to an internal Gavi document reviewed by Reuters.

The proposal will be discussed at the Gavi board meeting on Tuesday, and the change could be enacted in the fourth quarter of this year, the document said.

Asked why total vaccine coverage was not used earlier as a measure, Bruce Aylward, a senior WHO and Covax official, told Reuters that the allocation terms could not be changed without the consent of Covax’s more than 140 member countries, though he did not elaborate on the process of reaching consensus.

He added that hard data on vaccines’ efficacy, which strengthened the case for a change, was now available.

“What’s becoming interesting now, only in the last couple of months, is the divergence between cases and deaths as a result of vaccination coverage,” he said.

“We are learning that the single best indicator of mortality risk is the level of whole coverage, not just Covax coverage.”

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